| NPI | 1639129109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2013027461) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-108996) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2022-01-14 |